Electronic DSHS Forms
You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.
We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.
| Number | Form Name(asc) | File Format | |
|---|---|---|---|
| 10-509 | Pediatric Symptoms Checklist (PSC-17) | ||
| 27-053 | Paternity Information | ||
| 10-643 | PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
| 10-668 | PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration) | ||
| 07-081 | Participation Reimbursement | ||
| 04-449 | Participants Feedback (Domestic Violence Intervention Treatment) | ||
| 07-103A | Participant Reimbursement with Interpreter Declaration | ||
| 10-630 | Paid Feeding Assistant Program Review (Aging and Long-Term Support Administration) | ||
| 10-571 | Overnight Planned Respite Services Individualized Agreement | ||
| 10-639 | Overnight Planned Respite Services (OPRS) Certification Evaluation (Developmental Disabilities Administration) | ||
| 20-333 | Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration) | ||
| 13-920 | Outpatient Competency Restoration Program (OCRP) Discharge Summary | ||
| 27-063 | Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration) | ||
| 10-669 | Out-of-Home Services (OHS) Transition Checklist (Developmental Disabilities Administrations) | ||
| 15-567 | On-the-Job Facility Training Plan Application and Updates (Home and Community Services) | ||
| 05-248 | On-Site Review (Office of Refugee and Immigrant Assistance) | ||
| 02-740 | Office of Justice and Civil Rights Complaint Request | ||
| 17-238 | ODHH Approved Sign Language Interpreter Complaints | ||
| 13-780 | Nursing Services Basic Skin Assessment (Home and Community Services) | ||
| 13-784 | Nursing Services Assessment | ||
| 10-237 | Nursing Home Transfer or Discharge Notice (Residential Care Services) | ||
| 10-603 | Nursing Home Information Changes | ||
| 27-209 | Nursing Home Informal Dispute Resolution Request (Residential Care Services) | ||
| 10-670 | Nursing Home Facility License Application (Aging and Long-Term Support Administration) | ||
| 15-031 | Nursing Facility Notice of Action |
